Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary

Abstract

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Keywords: blood pressure; cardiovascular disease; hypertension; pharmacotherapy.

Figure 1.

Analytic framework for management of hypertension. BP indicates blood pressure; CAD, coronary artery disease; CV, cardiovascular; ESRD, end-stage renal disease; HTN, hypertension; KQ, key question, and MI, myocardial infarction.

Figure 2.

Conceptual model used to derive indirect evidence that helped to answer the question about laboratory testing. CKD indicates chronic kidney disease; DM, diabetes; HTN, hypertension; LVH, left ventricular hypertrophy; and PICO, population, intervention, comparison, and outcome.

Figure 3.

Recommendations in the World Health Organization Guideline: Pharmacological Treatment of Hypertension in Adults 2021. CVD indicates cardiovascular disease; and WHO, World Health Organization.

Figure 4.

Research gaps identified by Guideline Development Group (GDG) according to population, intervention, comparison, and outcome. BP indicates blood pressure; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; and HTN, hypertension.